Cardiology Rx for Change: improving clinical attention to tobacco use and secondhand smoke exposure in cardiology.

ABSTRACT

BACKGROUND: Heart disease is the leading cause of tobacco-related death in smokers and of deaths due to secondhand smoke (SHS) exposure in nonsmokers. This study centers on the development and evaluation of an evidence-based model curriculum for improving clinical attention to tobacco use and SHS exposure in cardiology. HYPOTHESIS: We hypothesized that the curriculum would be associated with improvements in clinician tobacco-related knowledge, attitudes, confidence, and counseling behaviors from pre-to post-training and at the 3-month follow-up. METHODS: The 1-hour Cardiology Rx for Change curriculum was evaluated with 22 cardiology fellows and 77 medical residents with consistent training effects observed between the 2 groups. RESULTS: Trainees' tobacco treatment knowledge increased significantly from pre- to post-training (t[81] = 6.51, P<0.001), and perceived barriers to providing cessation treatment decreased significantly (t[81] = -3.97, P<0.001). The changes, however, were not sustained at the 3-month follow-up, suggesting the need for booster training efforts. From pretraining to 3-month follow-up, the training was associated with significant sustained gains in clinician confidence for treating tobacco dependence (t[61] = 3.69, P = 0.001) and with improvements in clinicians assessing patients' readiness to quit smoking (from 61% to 79%, t[59] = 3.69,P<0.001) and providing assistance with quitting (from 47% to 59%, t[59] = 2.12, P = 0.038). Asking patients about tobacco use, advising cessation, and arranging follow-up also increased over time, but not significantly. All participants (100%) recommended the curriculum for dissemination to other training programs. CONCLUSIONS: Available online via http//rxforchange.ucsf.edu, Cardiology Rx for Change offers a packaged training tool for improving treatment of tobacco use and SHS exposure in cardiology care.